Antenatal Care Flashcards
Describe the clinical manifestations of hyperemesis gravidarum
- Intractable nausea + vomiting
- Weight loss
- Electrolyte disturbance (low sodium and sometimes low potassium)
- Hypokalemic, hypochloremic metabolic acidosis.
Identify the key elements in the treatment of hyperemesis gravidarum
- slow IV hydration (start off with normal Saline) - pregnancy is a thymine-deficient state
- Correct electrolyte disturbance - thymine, sodium, potassium
- Anti-emetic
B6 and doxylamine - work together to combat nausea and vomiting
other anti-emetic drugs
List the anti-emetic medications used in hyperemesis gravidarum and recognize the adverse effects of these medications
Odansteron - prevent nausea and vomiting, side effect - constipation
Metoclopramide - adr: extrapyramidal movements (anxious feeling, weird uncontrolled movements) - Benadryl given to reverse side effects.
Phenegron
Name the screening tests for Down syndrome
- Free fetal DNA
- Integrated, sequential, and contingency screening
- Quad screening - 15wks + 22 wks + 6 days
(mom’s blood is drawn to check foe hCG, estradiol, inhibin A, alpha fetoprotein) - 81%
Compare the timing, advantages, and disadvantages of the screening tests
Free fetal DNA - 99% accuracy
- 10 wks #- test mom’s blood -> baby’s DNA in moms blood -> karyotype
Integrated, Sequential, and contingency screening - 96% accuracy
- 11 wks - 13wks+6 days
- US to check fetal nuchal translucency (measure the skin fold behind the baby’s neck) + do maternal hormone blood work to check hCG + PAPPA
INTEGRATED
- take results from 1st-trimester test (nuchal translucency and blood work) and blood work from 2nd trimester (quad screening) - integrate them together to give picture of whether the baby is at risk for Down Syndrome
- Don’t get results till 2nd trimester
SEQUENTIAL
- take 1st trimester results
take 2nd-trimester result s
- overall result
CONTINGENCY
- 1st trimester results - if risk is low then don’t perform 2nd trimester tests
List the invasive testing techniques used to confirm the diagnosis of Down syndrome
If screening tests are abnormal - perform invasive testing
- Chorionic villi Sampling
- Aminocentesis
Compare the timing and potential complications of amniocentesis and chorionic sampling villi
CHORIONIC VILLI SAMPLING
- 10-14 wks
- needle inserted into the mom’s belly and a sample of chorionic villi is taken
- Karyotype performed
- Can be performed in early gestation
Risk: loss of pregnancy
AMNIOCENTESIS
- 15 wks
- Needle inserted and a sample of amniotic fluid is drawn.
- Karyotype performed
- Risk: bleeding, fetal loss, placental rupture, infection
Recognize the purpose of antenatal testing
- To ensure fetal well being
- Make sure there is no fetal asphyxia
Identify the role of the non-stress test in the assessment of fetal well-being
Performed by doing external fetal heart rate monitoring
- Results: Reactive or Non-reactive
- Reactive - 2 accelerations of greater than 15 bpm lasting at least 15s over 20 min period.
- If positive, well being of fetus is assured.
- Non-reactive:
- need additional testing to assure well-being.
Recall the criteria for a reactive non-stress test
2 accelerations of greater than 15 bpm lasting at least 15s over a 20 min period.
List the components of the biophysical profile
1) Fetal movement - 3 gross movements in 30 mins
2) Fetal tone - fine movements of fingers, hands, closing and opening of palms
3) Fetal Breathing - sustained breathing for 30 s
4) Amniotic fluid volume - maximal vertical pocket - greater than 2 cm
5) Non-stress test
Describe how to assess fetal movement, tone, and breathing
1) Fetal movement - 3 gross movements in 30 mins
2) Fetal tone - fine movements of fingers, hands, closing and opening of palms
3) Fetal Breathing - sustained breathing for 30 s
Name the parameter used to determine the amniotic fluid volume
> 2cm maximal vertical pocket
Recall the management guidelines for biophysical profile testing
greater than or equal to 8 = doing well, no signs of asphyxia
6 = equivocal, if pregnancy is at term - delivery is warranted
less than or equal to 4 = concerning for asphyxia
BPP can be used when NST is non-reactive
A modified BPP is a NST + amniotic fluid volume
Describe the procedure of the contraction stress test and recall the interpretation of its results
Procedure - induce contractions (nipple stimulation or by giving Pitocin)
- Observe contractions over 10 min time frame
We do not want the test to be positive
+ test result = >50% of contractions are to do with late deceleration
Equivocal test results = there are late decelerations but < 50%
- test results = < 50% contractions are associated with late decelerations
Late deceleration is defined as a visually apparent, gradual decrease in the fetal heart rate typically following the uterine contraction. The gradual decrease is defined as, from onset to nadir taking 30 seconds or more.8
State the indications of umbilical artery doppler
If suspected fetal growth restriction
- As resistance in the placenta increases, the flow can be absent during diastole or reversed.
